1104443035 NPI number — ST. LUKE'S WARREN PHYSICIAN GROUP, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104443035 NPI number — ST. LUKE'S WARREN PHYSICIAN GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104443035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 S COMMERCE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18017-8891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-526-3830
Provider Business Mailing Address Fax Number:
833-213-6428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 ROUTE 31 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-503-7546
Provider Business Practice Location Address Fax Number:
833-214-0129
Provider Enumeration Date:
06/26/2020

Additional Information

Authorized Official

Authorized Official Last Name:
CHIAVAROLI
Authorized Official First Name:
SUE
Authorized Official Middle Name:
Authorized Official Title or Position:
ENROLLMENT SUPERVISOR
Authorized Official Telephone Number:
484-526-3569

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com